HomeMy WebLinkAboutDisabilty_Robinsono �
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�� ag APPLICATION FOR BLIND OR DiSABLED PERSON'S
'DEDUCTION FROM ASSESSED VALUATION
S�ate Fortn d3710 (R7/ SO6)
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PresaiM.d by Ihe Departmeni d lo�al Gwemm¢nt Finvice
COUNTY TOWNSHIP - YEAR'
�Information contained in this document is CONFIDENTIAI pursuant to IC 72-1-7-1(n) and IC 6-7.1-12-72(b�.
INSTRUCTIONS:
To be /iled in person or by mail with the County Auditor o! lhe county where the property is located. Q� � 1 4 1��8
Filing Dates: 7J Real Property: Dunng the 72 months betore June 17 of the year fhe deduction is to be eNective.
2J Mobile Homes assessed under IC 6-7. 7-7: Durrng the 72 months belore March 2 0/ each yeaoFtye indi✓ ual wishes to
obtain lhe deduction. O'/a� /S��
C/ C/
See reverse side for additional instructions and uali(cations. • GIBSON COUNTY AUDITOR
Name of appliwni (q}vner or contract buyer) ^ n
� `✓ vv �C
If No, what is hisRier ezaU share of interest? If owned vrith someone other than spouse,
indicate with whom
or equitable owner?
�1�e5 ❑ No
n name on recora is tlitterent than•mat
Name of contrad se0er
� �
Address of contract sell r
Is applicant blind as defined in IC 12-1�
�5
Is Ne property used and occupied prirr
indicate below
Is the property in question:
❑ Real Property ❑ MoM1e Home (IC 61.1-7)
n) and IC 6-1.1-72-72(b)? Is applicant disabled and unable to engage in any substan6al gaintul activiry
as defined in IC 6-7J-12-'11(d)?
° es ❑ No
or his/her residence? Does the applicanPs laxable gross income for e preceding �alendar year
exceed $17,000?
O No Yes ❑ No
Key number! Legal description Record number Page number
a�-ia-I� 3oa-cba.o�o�a�
INJe certify under penalty of perjury that the above and foregoing information is Uue and covect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
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of authorized
representative